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All Journal Jurnal Sain Veteriner Jurnal Veteriner Berkala Ilmu Kesehatan Kulit dan Kelamin Folia Medica Indonesiana Jurnal Profesi Medika: Jurnal Kedokteran dan Kesehatan JBN (Jurnal Bedah Nasional) JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga Jurnal Psikiatri Surabaya (Surabaya Psychiatry Journal) Indian Journal of Forensic Medicine & Toxicology Jurnal Rekonstruksi dan Estetik MEDICINUS

Iswinarno Doso Saputro

Departemen Bedah Plastik Rekonstruksi Dan Estetik, Fakultas Kedokteran, Universitas Airlangga/RSUD Dr. Soetomo, Surabaya

Author-ID : 2896269

Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Veterinary Other

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CORELATION OF PARENTS’ PROFILES OF CHILDREN WITH LATE CLEFT REPAIR IN SURABAYA CLEFT LIP AND PALATE CENTRE (JANUARY 2015–DECEMBER 2017) Laras Puspita Ningrum; Iswinarno Doso Saputro; Lobredia Zarasade
Jurnal Rekonstruksi dan Estetik Vol. 5 No. 1 (2020): Jurnal Rekonstruksi dan Estetik, June 2020
Publisher : Universitas Airlangga

Highlights: Economic factors and insufficient information about cleft palate treatment was the primary cause of delayed repairs,except for Parents' education levels. The essential responsibility of primary care physicians is to provide education on treatment stages to minimize delays. Abstract: Introduction: Optimal time of Cleft palate repair is during the 10 to 12 month of age. In this time produce far natural results in terms of speech because it enabled the maturation of scar tissue postoperatively. The soft palate must function properly before the patient starts learning to talk, otherwise speech disorders such as persistent rhinolalia aperta might arise. In pediatric patients, the role of parents is very important on adherence to therapy. Methods: This is a cross-sectional study. The first study group was parents of patients who had surgical repair before two years old and the second group was the parents of patients who had repair after two years old. We compared age, monthly income, education level, number of children, and residential distance from Surabaya of the two groups. Results: The data of this study were obtained from the medical records of patients with cleft lip surgery at CLP Center Surabaya in 2015th-2017th with total of 358 patients, 172 were female and 186 were male. 52 patients with delayed cleft palate surgery. Patients’ parents in both groups were mostly 31- 40 years old, were high school graduated, has one child, earned less than 1.5 million rupiah a month, and lived less than 100 kms from Surabaya. From the statistical results, parent’s income has the strongest correlation with the patient’s age in cleft palate surgery (-2.7). A negative coefficient means that the less parent’s income, the more patient likely had delayed cleft palate surgery. While other factors found weak and very weak correlations. Conclusions:The results form patient's parents' interview, concluded that besides economic factors, the lack of information cleft palate treatment is the key factors that contributed to the delay of cleft palate repair. The education level does not affect the delay in cleft palate surgery, because even in high educated parents, sometimes they don’t understand the stages of cleft lip and palate treatment. This study emphasized the necessity to educate about the stages of surgery by primary care physicians, to minimize delays.

FACTORS INFLUENCING SKIN NECROSIS RESULTING FROM EXTRAVASATION INJURIES AND THE RAPEUTIC APPROACHES IN THE PEDIATRIC INPATIENT WARD (JANUARY-DECEMBER 2019) Iswinarno Doso Saputro; Agus Santoso Budi; Dhitta Aliefia Noverta
Jurnal Rekonstruksi dan Estetik Vol. 5 No. 1 (2020): Jurnal Rekonstruksi dan Estetik, June 2020
Publisher : Universitas Airlangga

Highlights: Skin necrotic injuries from extravasation were associated with age, the type of fluid/drug administered, and the location of the peripheral venous line, but not with gender. Autolytic debridement remains a prevalent and commonly used initial treatment approach for these injuries. Abstract: Introduction: Extravasation injury, a common complication of intravenous therapy in children, Interestingly, the complications arising from extravasation injuries could be more severe than the underlying medical conditions, sometimes even requiring amputation. The study aimed to identify the factors influencing the occurrence of skin necrosis due to extravasation injuries and to categorize the treatment approaches employed at Dr. Soetomo General Academic Hospital's pediatric facility in Surabaya from January to September 2019. Methods: This research takes a descriptive-analytic approach with a cross-sectional method. It involves examining data obtained from medical records. Specifically, the study focuses on the medical records of 44 pediatric patients who received treatment at Dr. Soetomo Hospital in Surabaya for skin necrosis resulting from extravasation injuries from January to December 2019. The analysis includes a retrospective review of patient information, looking at their characteristics, risk factors, the modalities used for wound care therapy, and the outcomes of their cases. Results: There were 44 cases of skin necrotic injury due to extravasation injury, with the largest percentage of neonates group (34%), male gender (66%), hypertonic fluids/drugs (73%), most regions of dorsum and wrist dextra (17%) and the most used therapeutic modality was autolytic debridement (45%). Conclusions: We found that the incidence of skin necrosis due to extravasation injury is influenced by factors such as the patient's age, the type of fluid or drug administered, and the location of the peripheral venous line. However, gender was not found to be a significant factor in the incidence of these injuries. Interestingly, the initial treatment approach that is still commonly employed is autolytic debridement.

MANDIBULR CONDYLE FRACTURE MANAGEMENT OUTCOME IN DEPARTMENT OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY, DR. SOETOMO GENERAL ACADEMIC HOSPITAL (2015-2018) Lobredia Zarasade; Iswinarno Doso Saputro; Nadia Tamara Putri
Jurnal Rekonstruksi dan Estetik Vol. 5 No. 1 (2020): Jurnal Rekonstruksi dan Estetik, June 2020
Publisher : Universitas Airlangga

Highlights: The management of mandibular condyle fractures is determined based on patient age, fracture type, systemic health, other maxillofacial fractures, and dental conditions factors. Out of the total patients indicating successful management of mandibular condyle fractures at Dr. Soetomo Hospital. Abstract: Introduction: The high incidence of condyle mandible fractures is due to the role of the mandibular ramus which has stronger resistance compared to head condyle mandibular. The management of condyle fractures is still controversial because of the prognosis. Management of condyle fractures of the mandible should aim at maximally reducing morbidity, postoperative complications, and aesthetic and/ or functional impairment. Methods: The medical records of 56 patients with condyle mandible fractures who presented at the Dr. Soetomo General Academic Hospital Surabaya from January 2015 to December 2018 were reviewed retrospectively. We analyzed characteristics of the patients (age), type of fractures, management of fractures, and outcome from management. Results: This study shows that a total of 56 patients, 22 were patients with mandibular condyle fractures only and 34 patients with mandibular condyle fractures with other maxillofacial fractures. The studied showed that male patients (84%) is more than female patients (16%). The mean age of the patients involved in this study was 28.25 ± 1.78 years, with the youngest being 12 years old and the oldest being 67 years old. The results of the overall study with good occlusion results in 48 patients, it was found that 22 patients were treated with closed reduction and 26 patients with open reduction were performed. Conclusions: The results of condyle mandibula fracture management in Dr. Soetomo Hospital has been according to the indication with the treatment indication along with the result of good management.

THE EFFECT OF PROPANOLOL ON C-REACTIVE PROTEIN IN PATIENTS WITH SEVERE BURNS AT DR. SOETOMO GENERAL ACADEMIC HOSPITAL, SURABAYA, INDONESIA Muhammad Aulia U H; Iswinarno Doso Saputro; Magda Rosalina Hutagalung
Jurnal Rekonstruksi dan Estetik Vol. 4 No. 1 (2019): Jurnal Rekonstruksi dan Estetik, June 2019
Publisher : Universitas Airlangga

Highlights: The biochemical marker of inflammation and suggests a potential mechanism through which propranolol affects hypermetabolism in burn patients. The administration of propranolol giving effectivity of hypermetabolism which is characterized by decreasing in CRP levels. Abstract: Introduction: The incidence of burns in Indonesia progressively increases with the increase in its population and industries. From January to September 2000, 158 patients were treated in the burn unit of Dr. Soetomo General Academic Hospital with a mortality rate reaching 5.8%. Burns have a direct effect in causing both local and systemic changes in the body, not occurring in other injuries. In severe burns, a hypermetabolic state can occur, which increases cardiac workload and causes muscle atrophy and other morbidities. The purpose of this study is to examine the effect of propranolol on the hypermetabolic state in severely burned patients by measuring various clinical & laboratory parameters. Methods: This is an experimental study using pre and post test control group design with the objective of assessing the treatment outcome with oral propranolol given in 15 consecutive days for burn patients involving 25%- 60% TBSA. Measurements were taken three times, on day 0.7 and 14. Discussion: Obtained 16 samples divided into 2 groups. In the treatment group, there was a significant decrease in CRP levels on days 0.7 and 14 (p <0.05). The Mid Arm Circumference variable did not obtain a significant decreasing on days 0.7 and 14. The albumin level studied showed a significant decreasing on day 0 & 7 days with a value of p=0.045. From the comparison between the two groups, there were significant differences in CRP levels on days 0 & 14, with the mean value of the treatment group -5.12 + 2.88 and the mean value of the control group 2.86 + 7.37, and the value of p = 0.019. Conclusions: This study successfully proved that the administration of propranolol can overcome the effects of hypermetabolism which is characterized by decreasing in CRP levels.

MULTIPLE BURR HOLE AS AN ALTERNATIVE TREATMENT FOR LARGE SCALP DEFECT Priscilla Valentin N; Iswinarno Doso Saputro
Jurnal Rekonstruksi dan Estetik Vol. 4 No. 1 (2019): Jurnal Rekonstruksi dan Estetik, June 2019
Publisher : Universitas Airlangga

Highlights: The alternative treatment for large scalp defect can used multiple cranial burr holes. Multiple cranial burr holes is safe, swift and effective for the skull bone expose of the periosteum. Abstract: Introduction: Scalp defect with exposed bones is a serious injury that is often occurred after electrical burn injury. The coverage treatment may vary from local flap to free flap. Coverage becomes a major problem when flaps fails or is contraindicated and resulting in further morbidity. In this paper we report 1 patient with large scalp defect after electrical burn injury. Case Illustration: We report 1 patient with large scalp defect after electrical burn, which treated in our department. Fourteen days after the electrical burn injury, surgical debridement was done by the plastic surgeon, and multiple burr holes were made by the neurosurgeon in the nonviable bone. The distance between each burr holes was 15 mm. The defect was keep moist with absorbent. The scalp defects were treated with soft tissue debridement every 3 days in the policlinics to keep the wound presented viable. To date, the wound already treated for 90 days. Discussion: The granulation tissue appears in between the burr holes within 14 days. After the defect was covered with granulation tissues, a further closure such as skin graft application was necessary. No postoperative infection, osteomyelitis, or cranial bone sequestration was reported in this case. Conclusions: Multiple cranial burr holes can be chosen as an alternative treatment for large scalp defect. These technique, allow the formation of a vascular bed suitable for skin grafting. This technique is safe, swift and effective for cases of extensive exposure for the skull bone expose of the periosteum following trauma.

MARJOLIN’S ULCER: MALIGNANT TRANSFORMATION FROM BURN SCAR Arif Tri Prasetyo; Sitti Rizaliyana; Iswinarno Doso Saputro
Jurnal Rekonstruksi dan Estetik Vol. 3 No. 1 (2018): Jurnal Rekonstruksi dan Estetik, June 2018
Publisher : Universitas Airlangga

Highlights: Marjolin's ulcer can develop into squamous cell carcinoma, typically resulting from chronic scar tissue due. Diagnosis and treatment follow standard malignant lesion protocols, with staging based on UICC classification using histopathological findings. Abstract: Introduction: Marjolin’s ulcer is a malignant lesion from a scar due to burn trauma, chronic osteomyelitis, chronic inflammation, or chronic fistulae. This type of ulcer is rare, usually progressively growing on unhealed wound, accompanied by chronic trauma especially burn scar. Marjolin’s ulcer can form different types of pathologies`. Squamous cell carcinoma is the most type of histology. Previously, there was 3 Marjolin’s ulcer reported in Indonesia. Case Illustration: Reporting 3 Marjolin’s ulcer case on Dr. Soetomo General Academic Hospital since 2008 to 2016. Two patients have history of unhealed chronic wound and one patient has history of burn injury 27 years ago. From the histopathology examination, all the results are squamous cell carcinoma. All patient undergo wide excision surgery done by surgical oncologist. All the defect is closed by flap modality. One patient’s defect is closed by latissimus dorsi flap, the other with anterolateral thigh free flap, and the latter is closed by latissimus dorsi free flap. Remain raw surface close by split thickness skin graft. Discussion: Marjolin’s ulcer is malignant lesion from scar due to burn trauma, chronic osteomyelitis, chronic inflammation, or chronic fistulae. Marjolin’s ulcer sometimes grow become squamous cell carcinoma although require a long time. Treatment this case is same the other malignancy. Diagnosis should be confirmed by clinical, radiological, and pathological. Staging can use the classification of UICC (Union for International Cancer Control) in accordance with the histopathological results. Conclusion: Surgery serves as the primary approach for achieving local control, and radiotherapy plays a supplementary role, which must be supported by vigilant oncological monitoring.

KLEBSIELLA PNEUMONIAE NECROTIZING FASCIITIS OF THE LOWER EXTREMITY IN A 7-MONTH-OLD MALE: A CASE REPORT Marelno Zakanito; Iswinarno Doso Saputro
Jurnal Rekonstruksi dan Estetik Vol. 4 No. 2 (2019): Jurnal Rekonstruksi dan Estetik, December 2019
Publisher : Universitas Airlangga

Highlights: Diagnosing necrotizing fasciitis (NF) was challenging because its symptoms may overlap with other soft tissue infections. Necrotizing Fasciitis K. Pneumoniae, a Rare Life-threatening Case. Abstract: Introduction: Klebsiella pneumoniae necrotizing fasciitis is an uncommon soft tissue infection characterized by rapidly progressing necrosis involving the skin, subcutaneous tissue, and fascia. This condition may result in gross morbidity and mortality if not treated in its early stages. In fact, the mortality rate of this condition is high, ranging from 25 to 35%. We present a case of 7-month-old male with K. pneumoniae necrotizing fasciitis of the lower extremity. Case Illustration: A 7-month-old male presented with large areas over both left and right inferior side of the lower limbs to the emergency department of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Physical examination revealed elevated heart rate of 136 times per minute and increased body temperature of 38oC. The large areas on both lower limbs were darkened, sloughed off, and very tender to palpation. A small area over the right hand was erythematous and sloughed off. Laboratory evaluation demonstrated decreased hemoglobin of 6.2 g/dL and elevated leukocyte of 28,850 g/dL. Blood cultures demonstrated that K. pneumoniae was present. Discussion: NF is usually hard to diagnose during the initial period. The findings of NF can overlap with other soft tissue infections including cellulitis, abscess or even compartment syndrome. The clinical manifestations of NF start around a week after the initiating event, with induration and edema, followed by 24 to 48 hours later by erythema or purple discoloration and increasing local fever In the next 48 to 72 hours, the skin turns smooth, bright, and serous, or hemorrhagic blisters develop. If unproperly treated, necrosis develops, and by the fifth or sixth day, the lesion turns black with a necrotic crust. Conclusions: K. pneumoniae necrotizing fasciitis is a rare but life- threatening disease. A high index of suspicion is required for early diagnosis and treatment of this condition

Co-Authors Agus Santoso Budi Arif Tri Prasetyo Aryati Dhitta Aliefia Noverta Dwi Murtiastutik Hasan, Helmia Hesty Aulia Palupi Huvi, Indira I Made Suka Adnyana Karimah, Azimatul Laras Puspita Ningrum Lobredia Zarasade Lobredia Zarasade Lynda Hariani Magda Rosalina Hutagalung Magda Rosalina Hutagalung Marelno Zakanito Medisa Primasari Muhaimin Rifa’i Muhammad Aulia U H Nadia Tamara Putri Nur Aida Priscilla Valentin N Rahel Yuana Sadikim Revita Widya Prasanti Rifqi Kurniawan Salsabilla Gina Rania Septin Mauludiyana Siti Isya Wahdini Sitti Rizaliyana Waode Fifin Ervina Willy Sandhika Wiwik Misaco Yuniarti Yoes Prijatna Dachlan

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